A case of useful short-spaced bipolar pacing of a left ventricular lead to avoid phrenic nerve stimulation

Tomoyuki Kabutoya, Yasushi Imai, Hiroaki Watanabe, Tomonori Watanabe, Takahiro Komori, Kazuomi Kario

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


48-year-old woman underwent cardiac resynchronization therapy defibrillator implantation. Coronary sinus (CS) venography showed only one adequate anterior branch for a left ventricular lead. We were able to introduce a quadripolar left ventricular lead (Medtronic 4398-88 cm) to the distal portion of the anterior branch. Although phrenic nerve stimulation (PNS) occurred due to distal bipolar pacing (distal 1–mid 2, with 21-mm distance) and proximal pacing (mid 3–proximal 4, distance 21mm), short-spaced bipolar pacing (mid 2-3, distance 1.3 mm) did not induce PNS until 9V pacing. Shared bipolar pacing from each left ventricular electrode (distal 1 to proximal 4) as cathode and a right ventricular (RV) coil as anode resulted in PNS by 3.0V at 0.4 ms. Although quadripolar pacing could avoid PNS by switching the pacing site (ie, from distal bipolar to proximal bipolar), it might not avoid PNS in cases where the phrenic nerve and CS branch are parallel and in close proximity. We found that even though the phrenic nerve and CS branch were parallel and close, short-spaced bipolar pacing could avoid PNS. In conclusion, short-spaced bipolar pacing selected by quadripolar pacing might be beneficial to avoid PNS when the implantable branch is limited.

Original languageEnglish
Pages (from-to)118-120
Number of pages3
JournalInternational Heart Journal
Issue number1
StatePublished - 19 Jan 2016
Externally publishedYes


  • Cardiac resynchronization therapy
  • Interelectrode spacing


Dive into the research topics of 'A case of useful short-spaced bipolar pacing of a left ventricular lead to avoid phrenic nerve stimulation'. Together they form a unique fingerprint.

Cite this